Provider Demographics
NPI:1447640404
Name:HATHOR, EVA ELAINE (LPC)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:ELAINE
Last Name:HATHOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 SCHOOL ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-2629
Mailing Address - Country:US
Mailing Address - Phone:336-667-1140
Mailing Address - Fax:336-667-1051
Practice Address - Street 1:1201 SCHOOL ST
Practice Address - Street 2:SUITE E
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2629
Practice Address - Country:US
Practice Address - Phone:336-667-1140
Practice Address - Fax:336-667-1051
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9818101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional